Beta-blockers in septic shock to optimize hemodynamics? We are not sure

Excerpt

In recent years, interest in the use of beta-blockade in sepsis has increased, bearing in mind that the septic heart may benefit from some protection against excessive adrenergic stimulation. Then, one trial suggested substantial improvement in survival following heart rate control by continuous infusion of esmolol, a short-acting selective beta-1 antagonist, in a highly selected group of septic shock with severe tachycardia [1]. The same group of researchers suggested potential positive effects on cardiac function from infusion of esmolol in a subsequent study in 45 septic shock with tachycardia above 95 bpm published in this issue [2]. In this study, esmolol-related decrease in heart rate was associated with increased stroke volume (SV). Owing to decreased cardiac contractility (as illustrated by the decrease in dP/dt _max), the preservation of SV can only result from increase in preload (related to the increase in diastolic time) or a decrease in afterload. Yet, the authors ascribed increase in SV to improved ventriculo-arterial coupling, as MAP/SV, an index of aortic elastance, improved while filling pressures were stable. …